Anesthetic Strategies for Managing Childbirth in Women with Aortic Coarctation in A Low-Diagnosis Setting: Insights from Five Cases

Background: The perioperative management of patients with congenital heart disease, such as aortic coarctation, presents significant challenges for anesthesiologists. The physiological and hormonal changes of pregnancy, particularly the increased hemodynamic load, are associated with a heightened risk of progressive aortic dilatation or dissection in these patients. our study aims to delineate the anesthetic strategies employed to optimize maternal and foetal outcomes. Methods: We conducted a cross-sectional study of women diagnosed with aortic coarctation who received care at the Monastir Maternity and Neonatal Center between March 1, 2013, and February 28, 2018. Results: The average maternal age was 27 years. Four women had pre-existing isthmic coarctation; one was diagnosed during pregnancy. Two had prior surgical repairs and one had undergone angioplasty. Comorbidities included rheumatic arthritis and hypertension. Common findings were hypertension (80%), murmurs (60%), and diminished femoral pulses (40%). Three patients had elective cesareans, one underwent an emergency cesarean, and one delivered vaginally. All received regional anesthesia, mainly combined spinal-epidural. Hemodynamics remained stable without vasoactive support. One case of uterine atony was managed effectively. All were monitored in ICU for 48 hours. Two infants were born prematurely, with APGAR scores of 8–10. No postpartum complications were observed. Conclusions: Regional anesthesia, especially combined spinal-epidural, was safe and effective for childbirth in women with aortic coarctation. Close multidisciplinary monitoring and individualized anesthetic planning contributed to stable maternal outcomes and favorable neonatal results. This study also suggests the potential underdiagnosis of aortic coarctation during pregnancy and underscores the need for routine cardiovascular screening in pregnant women with suggestive symptoms.